This paper has been prompted by the decision to close a large psychiatric hospital in its entirety and reprovide its services within the community. This was announced in 1983 with the aim that it would be effected within a ten year period. The hospital at that time had approximately 1,000 patients and the decision, which came as a shock to the staff, was taken not by the local management or clinicians but by the more distant administrative structure.

The recent formation of a Liaison Psychiatry Group within the College reflects the growing integration of psychiatry with other medical specialties in the general hospital. The Group was established to foster the development of psychiatry in relation to medical and surgical patients, including its clinical, teaching and research components. The title, Liaison Psychiatry, is not an ideal term but has become firmly established in other countries to denote that area of psychiatry where the psychiatrist has particular skills to contribute to the care of the physically ill, and to those in whom psychiatric disorder presents in somatic terms.1

The practice of psychiatry in the UK has for most of its existence been focused on the needs of adults, and it has been with this age group in mind that educational programmes and training needs have been formulated. It is not surprising, then, that the content and shape of psychiatric training programmes have followed this clinically-driven pattern. Trainees entering psychiatry begin their clinical careers working with adults or older people and are expected to obtain a grasp of the fundamental clinical tools of the trade working with these populations. Experience with younger people's mental health is explicitly excluded in the first year of training, emphasising the primacy of adulthood in the approach to learning clinical mental health skills.

Independent psychiatry beyond the National Health Service (NHS) is growing in the UK. However the history of the College can lead it to be NHS-centred in its outlook. Psychiatrists engaged in ‘private practice’ have at times been excluded from their collegiate peer group. We explore here the underlying and challenging issues of professional values, stigma, and occupational motivation. In the spirit of its commitment to raising standards, it is pleasing that the College is beginning to look beyond the NHS, supporting the professional development of non-NHS members, and including them in quality initiatives. We must all discover the value for patients in an open and independent perspective on what drives psychiatry in the UK.

The Internet, a military creation, is a collection of services shaped by its users, and offers the rapid transfer of vast quantities of information. Already there is concern that Developing World countries may be left behind by this revolution in information availability. Psychiatrists need to be aware of the type of facility the information in the superhighway provides, so that the useful aspects can be refined and directed. The type of facilities in use now by psychiatrists around the world is briefly described.

This article deals with the organisation and evaluation of a pilot series of seminars at the Institute of Psychiatry on the relevance of social anthropology to psychiatry. Despite increasing interest in the relationship of culture to psychiatry, trainees have few opportunities to learn about anthropological issues in psychiatric theory, practice and research. The present authors, all with higher degrees in social anthropology, believe that this is one of the first seminar series of its kind in the country specifically for mental health trainees. Some further possibilities for developing and applying this teaching are also considered.

Three hundred randomly selected fund-holding general practitioners were sent a questionnaire that asked them to indicate their priorities for child mental hearth services. They were also asked to rate their local child mental health services; 210 (70%) returned completed questionnaires. Items accorded the highest priority by the largest number of GPs included written communication, short waiting time following referral, sensitivity to patient's cultural background, child sexual abuse services, and mental handicap services. Child psychiatrists were seen as the most essential members of multidisciplinary teams, and family therapy was the most popular choice of treatment. Financial considerations did not appear to dictate GPs' choices. About half of respondents rated their local services as barely satisfactory, unsatisfactory or extremely unsatisfactory.

Greater care in the community will lead to the geographic dispersal of psychiatric services and the role of communications technology will become increasingly important. McLaren et al (1991) described the potential role for new communications technology, such as interactive television, in the provision of psychiatric services but before resorting to new communications technology it will be important to ensure that full use is being made of existing technology such as the telephone. The telephone is widely used in the UK health service but poorly understood, in contrast to the USA where it has been recognised as an important medium for care delivery (Hallam, 1989). This pilot study was designed to gather information on the current role of the telephone in an acute psychiatric service and to aid the planning of the use of more advanced communications technology such as interactive television.

The Working Party was set up to consider the question posed by the DHSS as to whether there should be a ‘teaching increment’ to the consultant target, i.e. should Districts with special teaching responsibilities have more consultants than similar ‘non-teaching’ Districts?

1. These recommendations are derived from the report of a working party on education and training set up by the Section for Social and Community Psychiatry in 1984. A companion paper deals with recommendations for Senior Registrar posts in Rehabilitation and in General Psychiatry. The recommendations for the most part do not represent new departures, but are mainly explicit descriptions of what is currently included in good training programmes, developments which are already increasing or recommendations made in previous documents. With the forthcoming expansion of psychiatric care in the community, appropriate training is increasingly required.

There are two medical schools in Hong Kong, that of the University of Hong Kong and that of the Chinese University of Hong Kong. The former has a history of more than 100 years whereas the latter admitted its first batch of students only in 1981. Both use English as the teaching medium and both are recognised by the GMC. I received my undergraduate medical education in the former but have been teaching in the latter for seven years.

The Owen/Russell thesis on the impact of mental illness on political leaders is considered. The importance of the issue is acknowledged. Using the examples of President Kennedy and the Shah of Iran it is argued that what constitutes good decision-making is contingent on circumstances and evaluated by outcomes. There are often alternative explanations to mental impairment for poor decision-making, and that hubris is not the only possible failing. Last, democratic systems have better mechanisms than authoritarian regimes to address the problems posed by leaders who are physically or mentally ill.